Provider Demographics
NPI:1114718160
Name:BENITEZ, GRACE ANGELICA (MSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANGELICA
Last Name:BENITEZ
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CREEK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-9524
Mailing Address - Country:US
Mailing Address - Phone:559-852-6259
Mailing Address - Fax:
Practice Address - Street 1:1000 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-2634
Practice Address - Country:US
Practice Address - Phone:573-774-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker